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LCQ16: Drug handling in residential care homes for the elderly

     Following is a question by the Hon Wong Sing-chi and a written reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (March 11):


     It has been reported that during the period from April 2006 to August 2008, the Hospital Authority received 39 reports of wrong intake of medicines by elderly residents in residential care homes for the elderly (RCHEs) and, among them, three elderly residents passed away allegedly because of this.  In this connection, will the Government inform this Council:

(a) of the number of reports received in each of the past three years of medicines being dispensed wrongly at RCHEs; whether it had carried out investigations into such incidents occurring in private and government-aided RCHEs respectively; if so, of the respective details; if not, the reasons for that;

(b) whether it will step up regulation on private and government-aided RCHEs respectively and require that they must comply with the relevant stipulations in the Code of Practice for Residential Care Homes (Elderly Persons) when dispensing medicines; if so, of the respective details; if not, the reasons for that; and

(c) whether it will consider increasing the subventions granted to private and government-aided RCHEs respectively, so as to minimise the incidents of medicines being dispensed wrongly which are caused by insufficient manpower in the institutions; if so, of the respective details; if not, the reasons for that?

Reply :


     My reply to Hon Wong Sing-chi's question is as follows:

(a)  In the past three years, the Social Welfare Department (SWD) received a total of 100 complaints, referrals or self-reported cases by residential care homes for the elderly (RCHEs) about suspected cases of improper handling of drugs in RCHEs, ie an average of about 33 cases a year.  Those 100 cases include the 39 suspected cases of wrong intake of hypoglycemic agents by elders reported from April 2006 to August 2008 as mentioned in the question.

     On learning about such cases, the Licensing Office of Residential Care Homes for the Elderly (LORCHE) under SWD will immediately conduct investigations, including unannounced inspections of the concerned RCHEs, examination of their drug handling records, and meetings with staff members and elderly residents of the concerned RCHEs to enquire about the incidents.  For substantiated cases involving staff negligence or deficiencies in the drug management systems of RCHEs, LORCHE will issue advice or warning to the concerned RCHE and follow up the case closely to ensure that corresponding improvements will be made.  

     LORCHE has completed the investigations into the above 100 cases, 80 of which were substantiated. These cases involved wrong intake of drugs, omission of prescribed drugs in drug distribution, repeated distribution of drugs, inaccurate dosage of drugs, or taking drugs at wrong timing, etc.  The incidents were mainly caused by the failure of staff in following the correct drug handling procedures.  Taking into account the nature and severity of individual cases, LORCHE has issued advice or warning to the RCHEs and staff concerned, and has referred them to receive training on drug handling provided by the Visiting Health Teams (VHTs) of the Department of Health (DH). LORCHE will continue to monitor these RCHEs closely to ensure that they have adopted effective improvement measures.    

(b) All RCHEs that have obtained an RCHE licence from SWD (whether they are subsidised or private RCHEs) are required to comply with the Code of Practice for Residential Care Homes (Elderly Persons) issued by SWD. The Code has set out clearly the requirements on storage and management of drugs in RCHEs.  Besides, SWD, DH and the Hospital Authority (HA) have jointly compiled a drug management manual in early 2007, which has provided clear and detailed guidelines on the major procedures in drug management including the storage, preparation, sorting, checking and distribution of drugs.  The manual also provides standardised flow charts illustrating the relevant procedures for RCHE staff to follow.  Moreover, SWD issues circulars to RCHEs from time to time to remind their staff to strictly follow the proper procedures in drug management.

     LORCHE will pay special attention to the performance of RCHEs in drug management during their inspections, and will refer RCHE staff to receive training on drug handling provided by DH's VHTs where necessary.  In case LORCHE comes across any negligence or non-compliance of RCHE in drug handling, it will issue advice or warning to the concerned RCHE based on the nature and severity of the case.  If the concerned RCHE fails to make appropriate improvements, SWD will consider taking prosecution actions in accordance with the Residential Care Homes (Elderly Persons) Ordinance.  To ensure effective monitoring in this respect, LORCHE created five Health Inspectorate posts in 2006 which were undertaken by registered nurses to strengthen the monitoring of health and care services in RCHEs, including the storage and management of drugs.

     In addition, LORCHE will target at RCHEs with more non-compliance records, and increase the frequencies of both routine and unannounced inspections of such RCHEs.  LORCHE will also conduct inspections during non-office hours, on Sundays and public holidays, and focus more on high-risk items such as drug management.

(c) As mentioned above, drug-related incidents in RCHEs are usually caused by the failure of staff in following the correct drug handling procedures.  As such, the Government has all along considered that it will be more effective to enhance the knowledge and capability of RCHEs and their staff in drug management through the provision of clear guidelines and appropriate training, which will help reduce the risk of drug-related incidents, instead of direct subsidy or manpower to RCHEs.  Therefore, apart from the above-mentioned drug management manual which was jointly compiled by SWD, DH and HA, four briefing sessions on the manual were organised by SWD, DH and HA in 2007 to explain the key points in the manual. The four briefing sessions attracted over 1,500 participants. In 2008, the concerned departments further organised three refresher courses on drug management in RCHEs to strengthen the knowledge and skills of RCHE staff on drug management, which attracted over 950 participants.  In 2009, SWD and DH will co-organise four workshops on nursing care to train new recruits and rejoining staff of RCHEs.  Drug management is one of the key training items.  The first workshop has already been held on March 2, 2009 with about 550 participants.  Where necessary, RCHEs can also approach DH's VHTs for tailor-made on-site training so as to further improve the knowledge of their staff in drug management.

     To alleviate the problem of nurse shortage in RCHEs, SWD collaborated with HA to organise a two-year full-time Enrolled Nurses Training Programme for the social welfare sector.  A total of four classes were organised from 2006 to 2008.  Another four classes will be organised in phases from now to 2011.  A total of 930 training places will be provided in all eight classes.  The tuition fees are subsidised by the Government, and graduates are required to work in the social welfare sector for at least two years after graduation.  Trainees of the first two classes of the Enrolled Nurses Training Programme graduated in April and October 2008 respectively.  Among the first batch of graduates, about 78% are now working in the social welfare sector.

Ends/Wednesday, March 11, 2009
Issued at HKT 12:26


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